Use of Crib Sheets and Exam Performance in an Undergraduate Nursing Course

Background: There is a growing body of evidence that the use of student-prepared testing aids (cheat sheets or crib notes) can have a positive impact on student outcomes such as test anxiety and exam performance. Some researchers have suggested that the actual preparation of a crib sheet can help students to organize course content, reduce the need for memorization, and focus on conceptual knowledge and learning. A review of the literature indicates faculty-approved crib sheets during exams are becoming more common in the disciplines of math, engineering, psychology, and other sciences. There are little to no published studies on the use of authorized crib sheets with nursing students.

Purpose: A repeated measures, correlational study was conducted to assess the outcomes of allowing baccalaureate nursing students to use authorized crib sheets during exams.

Methods: Senior nursing students (N=86), enrolled in a community health nursing course, received a blank crib sheet (10 cm X 15 cm index card) one week before each exam. The students were allowed to write on the front and back of the index card and then use it during the exam. Use of the sheet was not required. The crib sheet was collected after each exam and the students completed a post-exam survey developed by the researchers. The survey included five scaled questions assessing the benefits of using the crib sheet across the domains of Exam Confidence, Exam Preparedness, Test Anxiety, Assistance during Exam, and Recommend for Future Exams. Other survey items collected data on amount of time spent creating the crib sheet and number of times crib sheet was used during exam. One open-ended question requested additional written feedback.

Results: Even though it was not required, of the 86 students, 82 students (95%) used the crib sheet for all 3 of the exams. A repeated measures ANOVA found significant changes on all variables. For example, mean time creating the crib sheet was much longer (p<.001) for Exam 2 (M = 218.2) and the Final Exam (M = 230.89) compared to Exam 1(M = 151.79). The average number of times looking at the crib sheet during the exam was also greater (p<.001) for Exam 2 and the Final Exam (6-10 times) than in Exam 1 (2-5 times). Spearman’s rho correlations were used to examine the relationships between exam grades, confidence, preparation, anxiety, assistance during exam, and recommendation with time creating and looking at the sheet. Looking at the crib sheet during the exams was positively correlated to confidence, preparedness, decreased anxiety, assistance, and future recommendation. The amount of time creating the sheet was also positively correlated to these same outcomes except for assistance. The crib sheet usage was not correlated to exam grade overall. Themes from the qualitative data included “creating the card helped me learn/memorize,” and the “card was a security blanket during exams.”

Conclusion: Not only did almost all of the students use the crib sheets, but they overwhelmingly considered it to be a “great study tool.” This was the first course that allowed the faculty-approved crib sheet and the students commented they wished other courses would allow this study aid. By the Final Exam, the students were spending more time creating the crib sheet and using it more during the exam. Increasing the amount of time to create the sheet and number of times looking at the sheet during the exam could decrease anxiety.